"They call me MISTER Tibbs!"
I have had quite a week, a week that has revealed to me much of America's corporate and medical values. What I have experienced has left me angry and disgusted with both.
My wife continues to recover four months after removal of a very large, benign brain tumor. This has left her with dense left facial weakness. She is improving slowly, but it is a frustrating and demoralizing process. Her worst symptoms come from her difficulty blinking; her left eye is constantly dry and irritated. Imagine the feeling you get when dust or sand gets in your eye. Now imagine being unable to make that feeling go away. Ever. Constant, varying in intensity, but constant. Now have a doctor tell you it's part of recovery, that 'we'll see how much function you recover', and 'if you do not recover we can discuss surgical treatment.' If. A casual if, that only means life-altering, persistent pain.
These physicians are at a world-famous, academic medical center. Her treatment has been technically expert. And emotionally obtuse. The physicians care about nothing except the technical perfection and interest of their work. There is no response to or even acknowledgement of human suffering, fear, depression, dysfunction. If such things are brought up their eyes skate away and they talk about psychiatrists and anti-depressants. What is necessary, and glaringly absent, are words of comfort and encouragement, a promise to relieve suffering that is both physical and emotional.
I have also learned first hand. In private practice, I knew everyone in town, could pick up the phone and get an appointment. And in a place and time of private practices, I could walk in and be ushered back by a receptionist who had been alerted to my arrival. I rarely waited for anyone, and neither did my family. Now, between my clinical retirement, electronic medical records, and centralized scheduling systems, I am nothing but a social security number and date of birth to every medical service with which I interact. It takes 20 minutes just to refill my prescriptions, 'helped' by someone for whom English is clearly a third language and whose only touchstone to me or even America is a computer screen in the Philippines or where ever they are. I must repeatedly produce insurance information, a further reduction of the person to a number. And this isn't just for medication refills, it's for every physician I have to see.
At my work, where I provide medical oversight for several pharmaceutical labs, I am much loved and respected. I give monthly CME programs that are, by the description of everyone there, very different and much better than what they had previously. We have, however, a new head of quality for one of these labs, with whom I have interacted the last two weeks. The first time he told me my CME programs were not covering the required elements. I was not discussing a local reaction, and I was not printing out a reactions summary report. The next week he told me he was instituting a checklist for me, because I was missing things. He noted certain required elements had not been done on occasion. No sense of how often, no asking of why. Merely a condescending, supercilious accusation, this from a newcomer who knows nothing of what is going on in the office, only that boxes in checklists aren't being checked.
Managers are taught, TAUGHT, that their employees, their 'workers', are fungible, entirely replaceable. If one is more valued or valuable than another you are not managing correctly. That's insane; people vary in their motivation and abilities. The methods taught to today's 'managers' guarantee performance, but at a low level. The most capable and interactive become demoralized as they realize their personal and work skills are not valued, only their ability to fill a limited job description.
And everything is measured by money. Cheap, young workers with little life experience and less compassion are preferred over older but more expensive workers. Physicians are not judged by their interpersonal abilities but rather by how much money they bring in to the large medical conglomerates that now employ them. Things like kindness, interaction, and compassion interfere with throughput. They are as relevant to today's management as they would be to an auto worker making fenders.
Well I'm not a fender.
My wife happily talked about the projects we could do in our first home. I replied, with some passion, "I went to school to earn enough money to pay someone else to do this!" That was only partially true.
I went to school to gain enough knowledge and credentials that I would never be condescended to or treated like a number. To have safety from mistreatment, being ignored, having my needs dismissed summarily. And now, in a position and at an age where I expect deference, politeness, and respect, I find I am treated more like a commodity than ever before. And I am completely intolerant of this. I am not a 'thing', and my wife and my family are not 'things' either. I demand to be treated with the respect and deference I have earned; indeed, I demand what I gave in my own practice- deference, consideration, kindness, and respect to EVERYONE who walked in the door- rich, poor, young, old, black, white. You do not treat people badly when they come for care, or when they work for you. As you have done it to the least, so you have done it to Me. Except today's youth and 'managers' are as ignorant of the Bible as they are of history and other humanities. Their professional efforts cannot be enlightened by that of which they know nothing.
I am rapidly becoming a difficult, oppositional older man. I absolutely refuse to be mistreated, and I am vocal in my insistence. I AM called Doctor Tsaltas, and don't you ever forget it, you miserable, ill-educated, ill-mannered bastards.
Ted
I couldn’t agree more with you Ted. In today’s medical society people are treated, they are no longer cared for. Everything is about money and not about the important things like respect compassion sincerity and equality.
ReplyDeleteLast month I had two disparate experiences in two hospitals two days apart with ER doctors. I was suffering terribly painful campylobacter jejuni; however, the culture had yet to show that; meanwhile all other tests were showing nothing atypical for me. The first ER doctor sent me home with these words, “Your labs look better than ever.” First I knew it was a lie, because I had seen those lab results on the portal before he came in. Second of all it was demeaning. Two days later, at Mass General after an observational stay, I was sent home with these words, “You are medically safe to go home.” What a difference in explanation and respectfulness.
ReplyDeleteTed, I loved your latest post called MisterTibbs. Your post really hit the nail on the head. It was a breath of fresh air to see someone say something that had needed to be said for a long time. This was one of the best posts I've ever read. All I can say is "Good for you and thank you for speaking on behalf of so many of us." I am proud to call you Dr. Tsaltas.
ReplyDeleteIn coming back to America after 13 years abroad, I worked as a corporate employed physician in a small town for a year. It was a valuable year for learning what really mattered to corporate medicine - profit, good public image, and staying out of legal problems. Patients and employees? Mere means to an end.
ReplyDeleteI am thankful that I now work in private practice. A real human being answers the phone in our office, we do all of our own scheduling (i.e., we don't use a centralized scheduling service), we can spend as much or as little time with patients as WE feel necessary (not being pushed for "production" by corporate) so that we can ask those questions about suffering, and we are the only office in town that does not use those cursed Electronic Medical Records.
If the United States government ever decides to underwrite medical care in this country to create "Universal Healthcare," there is more than just financial consideration that should be taken into account. Tort reform, pharmaceutical reform, and reforms to Medicare and Medicaid that will encourage a return to private practice and a trend away from corporate medicine are a few of the many things that will also need to be discussed.
As with the neophyte "head of quality" who is presuming to instruct you on the "correct" way to conduct your CME lectures, much needs to be changed in U.S. medicine so that the tail stops trying to wag the dog.
-D-